The role, challenges, and innovations of rifampin in the management of periprosthetic joint infections: a narrative review.
6 affiliations
- 1Orthopaedics and Sports Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102218, China.
- 2Institute of Orthopaedics and Sports Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102218, China.
- 3Beijing Key Laboratory of Multimodal Intelligent Diagnosis and Therapy for Bone and Joint Injuries & Diseases, Beijing, 102218, China.
- 4Orthopaedics and Sports Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102218, China. [email protected].
- 5Institute of Orthopaedics and Sports Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102218, China. [email protected].
- 6Beijing Key Laboratory of Multimodal Intelligent Diagnosis and Therapy for Bone and Joint Injuries & Diseases, Beijing, 102218, China. [email protected].
Abstract
Periprosthetic joint infection (PJI) remains a severe complication due to persistent bacterial biofilms. Rifampin is traditionally valued for its unique biofilm-penetrating properties, yet its clinical role is increasingly viewed as context-dependent. While current evidence supports the efficacy of rifampin in two-stage revision arthroplasty, its application in debridement, antibiotics, and implant retention (DAIR) remains a subject of ongoing debate. Landmark randomized trials once reported superior cure rates for DAIR combined with rifampin, but contemporary large-scale retrospective data show no statistically significant difference in remission rates, often accompanied by a significantly higher incidence of adverse events. Furthermore, the timing of administration is critical; early initiation within five days post-DAIR has been linked to increased treatment failure. These challenges, alongside profound drug-drug interactions, have spurred interest in localized delivery innovations like microencapsulation and nanoparticles. While these bioengineering approaches show preclinical promise in overcoming PMMA chemical incompatibility, they remain at the proof-of-concept stage. Consequently, rifampin should be employed as a targeted adjunct rather than a universal standard, requiring careful consideration of surgical strategy, patient tolerance, and optimal timing.
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BibTeX
@article{zhao2026role,
title = {{The role, challenges, and innovations of rifampin in the management of periprosthetic joint infections: a narrative review.}},
author = {Xijiu Zhao and Tiejian Li and Qi Ma and Jiawang Lou and Xu Cai and Changjiao Sun},
journal = {Arthroplasty (London, England)},
year = {2026},
month = nov,
doi = {10.1186/s42836-026-00445-z},
url = {https://europepmc.org/article/MED/42972577},
note = {CC BY},
}
RIS
TY - JOUR
TI - The role, challenges, and innovations of rifampin in the management of periprosthetic joint infections: a narrative review.
AU - Xijiu Zhao
AU - Tiejian Li
AU - Qi Ma
AU - Jiawang Lou
AU - Xu Cai
AU - Changjiao Sun
PY - 2026
DA - 2026/11/03
JO - Arthroplasty (London, England)
DO - 10.1186/s42836-026-00445-z
UR - https://europepmc.org/article/MED/42972577
AB - Periprosthetic joint infection (PJI) remains a severe complication due to persistent bacterial biofilms. Rifampin is traditionally valued for its unique biofilm-penetrating properties, yet its clinical role is increasingly viewed as context-dependent. While current evidence supports the efficacy of rifampin in two-stage revision arthroplasty, its application in debridement, antibiotics, and implant retention (DAIR) remains a subject of ongoing debate. Landmark randomized trials once reported superior cure rates for DAIR combined with rifampin, but contemporary large-scale retrospective data show no statistically significant difference in remission rates, often accompanied by a significantly higher incidence of adverse events. Furthermore, the timing of administration is critical; early initiation within five days post-DAIR has been linked to increased treatment failure. These challenges, alongside profound drug-drug interactions, have spurred interest in localized delivery innovations like microencapsulation and nanoparticles. While these bioengineering approaches show preclinical promise in overcoming PMMA chemical incompatibility, they remain at the proof-of-concept stage. Consequently, rifampin should be employed as a targeted adjunct rather than a universal standard, requiring careful consideration of surgical strategy, patient tolerance, and optimal timing.
SN - 2524-7948
ER -